The need to go out on disability leave is based on one’s inability to perform the duties of their occupation, not on the choice to step away from working. If you obtained disability coverage through your employer, the need to stop working due to a sickness or injury must occur while you are still employed. In our practice, we have noticed a particular “disconnect” between the disabled person’s intention to convey their need to stop working and the impact their choice of words has on the disability assessment.
Accepting that you are disabled can be very difficult and uncomfortable. This is especially true for our skilled and/or high-level professional clients such as doctors, lawyers, and corporate executives. It often feels easier to tell patients, clients, and employees that you are “retiring”, rather than admit you can no longer perform the job and need to step away. Many of our clients wonder, does it really matter what word is used? As recently seen in Cameron v. Sun Life Assur. Co. of Can., the answer is a resounding yes. 2022 U.S. Dist. LEXIS 200078 (C.D. Cal. Nov. 2, 2022).
In Cameron, the plaintiff was a radiology administrator who became disabled by a cardiac condition. He returned to work for a short period time, then determined that he would need to stop permanently due to the stressful nature of his job, which was impacting his health. Instead of returning to his doctor to address his ongoing symptoms, he “retired” from work. Months later, his condition continued to progress and manifest symptoms supporting his decision to stop working.
His employer’s long term disability insurer SunLife was solely interested in whether there was a medical record indicating that his disability continued as of the date that he stopped working. (resigned from work) Unfortunately, there was no such record because his doctor had simply noted that he was retiring due to the impact of work stress on his heart condition. The Court determined that his doctors’ notation of “retired” instead of “could not continue working due to the exacerbation of his cardiac condition due to work stress” “establish[ed] the end date of [his] entitlement to benefits.” Once he retired from work for his employer, he was no longer insured under his employer’s policy. In reality, he stopped working because of his medical condition!
We also face an uphill battle with insurers when we step in to represent individuals who already filed their claims, and noted that they “retired”, rather than to admit they were unable to continue working due to a disability. Once that message is conveyed to the insurer, it takes a lot of effort to convince them that this was not a choice to stop working, but a necessity due to functional physical or mental impairment.
If you are disabled, we suggest that you do not ever use the term “retired” to explain your absence from work, not just with your doctors but also in your statements and documentation to your insurance company. Do not indicate, either verbally or in any forms that you complete, that you have retired. Instead, be sure to note that you stopped working due to a medical condition. An experienced attorney can help guide you through this process.
We at Bonny G. Rafel LLC, provide legal counsel to individuals seeking to obtain (or overcome the denial of) long term disability benefits, and advocate for our clients as the Voice of the Disabled. See our website for video presentations and information on our boutique practice and contact us to discuss your case. www.disabilitycounsel.com.